预防胎膜灶破的现代管理(英文)Modern-Management-of-Prolonged-R课件.ppt
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- 预防 胎膜 现代 管理 英文 Modern Management of Prolonged 课件
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1、Modern Management of Prolonged Rupture of MembranesJoseph R.Biggio Jr.,M.D.Department of Obstetrics&GynecologyDivision of Maternal-Fetal MedicineUniversity of Alabama at BirminghamPROMAmniorrhexis prior to onset of active labor regardless of gestational agePremature Rupture of MembranesPPROMAmniorrh
2、exis 5,000 women randomizednOxytocin,PGE2 or expectant management up to 4 daysnNo difference in cesarean section or neonatal infectionnLess chorioamnionitis in induction with oxytocin groupHannah,NEJM,1996Epidemiology of Preterm BirthPPROM Spontaneous Preterm Delivery Indicated Preterm Delivery 28%4
3、6%26%Andrews,1995PPROMRisk FactorslLower/Upper Genital Tract InfectioniProteasesiProstaglandinslHistory of PPROMlIncompetent CervixlAbruptionlPolyhydramnioslMultiple GestationlSmokingPPROMComplicationslMaternal/Fetal InfectionlPremature Labor and DeliverylUmbilical Cord ProlapselFetal Hypoxia 2 Cord
4、 CompressionlIncreased Rate of Cesarean SectionlIntrauterine Growth RestrictionlAbruptionlStillbirthPPROMStandard ManagementlConfirmation of DiagnosislVerification of Gestational AgelR/O Labor/Infection/Fetal CompromiselAvoid Digital Vaginal ExaminationslIn Hospital ObservationlBedrestPPROMLatency G
5、estational Age(Weeks)%Patients with Latency 1 Week2550752525-2829-3233-360Wilson,Obstetrics&Gynecology,1982PPROMVaginal Examination24-2626-2828-3030-3232-3434-35Gestational Age(Weeks)2015105Latency DaysNo ExamExamLewis,Obstetrics&Gynecology,1992Previable PPROMl37S S u ur rv vi i v va al l1 10 00 02
6、25 55 50 07 75 5G G e es st ta at ti i o on na al l A A g ge e (W W e ee ek ks s)R R D D S SI IV V H HN N E E C CS S e ep ps si i s s0 0RNICU Survival and Morbidity Data(1995-1996)2325272931333537S Su ur rv vi i v va al l1 10 00 02 25 55 50 07 75 5W W e ee ek ks sR RD DS SI I V VH HN NE EC CS Se ep
7、ps si i s s%NeonatesTocolysisTocolysis(n=33)Bedrest(n=42)Gestational age30.029.4Days gained6.75.2 48 hr87.9%76.2%RDS45.4%52.4%Sepsis9.1%7.1%NEC18.2%23.8%Neonatal death9.1%11.9%PPROMTocolysisWeiner,AJOG,1988Tocolysis(n=39)Expectant(n=40)Gestational age27.927.3Days gained11.512.0 48 hr77%75%RDS51%58%S
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